Falls in Skilled Nursing Facilities: Bedrooms are the Real Danger Zone

We combined the falls data from multiple skilled nursing facilities with similar facility characteristics for a total of 48 facility-months to determine which physical-plant areas and what other factors were most closely associated with resident’s fall(s) in each of the facilities.

Using a Quality Improvement (QI) statistical package we analyzed this information. The data points we looked at include: number of falls per resident, time of day, day of week, the location, and activity at time of fall. In addition, we were able to analyze injuries and hospitalizations. We then combined those data points to determine which factors had the highest correlation with falls.

Our results reveal that for the 1246 falls analyzed:

Location:

Ø 77% occurred in the resident’s individual room

Time:

Ø Fewest falls occurred between midnight and 6 am

Injury:

Ø No Injury 64% (range between 58% and 77 %)

Ø Injury Sustained 36% (range 23% to 42%)

Ø Total Fractures 1.9% of Falls and 4% of Injuries

Ø Hip Fractures <1% of Falls and 1.6% of Injuries

Ø Head Injuries 2.6 % of Falls and 5.7 % of Injuries

Hospital:

Ø Transport to Hospital: 3.7% of Falls and 8% of Injuries

Facilities will likely benefit by concentrating on providing the safest bedroom design possible. Programs designed to address falls in resident bedrooms should be emphasized. We presume that many patients fall while rising or lowering themselves to bed, so improving systems to anticipate when this simple event occurs would be most fruitful in decreasing falls and therefore injuries to the residents. No other factors that we looked at had as significant of a correlation, despite the fact that at times facilities postulate on all sorts of various causes with no statistical backing for many such assumptions. Empowering all facility staff to be alert to risk factors that can lead to injuries from falls, and then responding to that input may be the most effective deterrent to fall injuries and/or repeat falls. Providing activities and encouraging residents to be out of their rooms may be an additional factor in decreasing falls/injuries in the bedroom. Although we can make every effort to make the resident bedrooms as safe as possible, we will not eliminate falls or injuries, but may minimize the number of and the morbidity of these events.

(c) Scott Matthew Bolhack MD, MBA, CMD, CWS, FACP, FAAP

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